A244 ENDOSCOPIC REMOVAL OF MIGRATED INTRAUTERINE DEVICE: CASE REPORT AND REVIEW OF LITERATURE

Intrauterine devices (IUDs) are an increasingly common and proven effective contraceptive method. Uterine perforation and IUD migration occurs at a rate of 0.3–2.6 per 1000 and is largely dependent on the experience of the inserter. Ectopic IUDs have been reported in the peritoneum, bladder, adnexa and bowel. Migration of the perforated IUD into the bowel is rare and requires removal. Surgical removal of IUDs by laparotomy has been widely described; however, reports of endoscopic removal are few and may offer a safer alternative. To describe a case of IUD migration into the bowel with successful endoscopic removal. Patient consent was obtained. Patient information from electronic records was extracted, including admission notes and procedural reports. A literature review was performed using Pubmed and the search term “((intrauterine device colon) OR intrauterine device rectum) OR intrauterine device bowel”. A previously healthy 37-year-old female presented to her family doctor with a 6-month history of left lower quadrant abdominal pain. She had a history of IUD placement 2.5 years prior. She had become pregnant 6 months after insertion, when it was assumed the IUD had fallen out. Subsequent abdominal ultrasound revealed an echogenic focus at the uterine fundus. A computed tomography scan localized the IUD to the outside of the uterine cavity with the vertical arm in the myometrium or serosa. The T-limb was localized to the rectal lumen and the anterior margin of the rectal wall. After the patient was admitted to hospital, the IUD was removed by flexible sigmoidoscopy using a crocodile grasper and snare. Extraction of the IUD was uncomplicated, well-tolerated, and the patient was discharged later on the same day. No prophylactic hemostasis or antimicrobial coverage was required. Review of the literature identified 25 cases of ectopic IUDs removed through the anus. Ten cases used colonoscopy or flexible sigmoidoscopy. Earlier reported cases used proctoscopes or rigid sigmoidoscopes. Forceps of various types were used in most cases, with some colonoscopic cases using snares as well. One case used a sphincterotome and dormia basket. Antimicrobial coverage peri-procedurally was variable. While statistically rare, the increasing use of IUDs will likely result in a proportional increase in cases of IUD migration into the bowel. We recommend close investigation and follow-up when pregnancy or other suggestive signs of IUD migration occur. Currently, the majority of identified cases are removed by laporotomy. Endoscopic removal results in less morbidity and should be considered as an alternative. Endoscopy is a safe and cost-effective technique for extraction of IUDs in the bowel lumen. None

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